An out-of-this-world design hits the high notes

From the moment he first picked up the French horn, Jacob Factor has battled through pain. The PhD student in music education at the University of Rochester’s Eastman School of Music has a rare throat condition called pharyngoceles, which causes the walls of his throat to bulge with pockets of air, resulting in extreme discomfort, particularly when he needs higher internal pressure to hit high notes or play at louder volumes.

“It feels like getting stabbed in the throat,” says Factor, who has had the condition since birth. “My neck would be throbbing if I had a hard playing week, and I would have to put down the instrument for a day.”

Despite years of muddled advice from perplexed instructors, Factor continued to adapt and persevere, pursuing graduate studies at one of the world’s top music schools. When he arrived at Eastman, he was able to tap into URochester’s wider network of expertise and search for a way to ease the discomfort. What he found was a team of otolaryngologists, biomedical engineers, and audio engineers who designed and tested an assistive brace that has him playing stronger, at higher ranges, and more confidently than ever before.

Brace for impact

While studying at Eastman, Factor connected with Glenn Schneider, an otolaryngologist at University of Rochester Medicine who specializes in treating larynx disorders, including voice disorders in singers and other professional voice users, dysphasia, and upper airway issues. Schneider helped Factor understand how his pharyngoceles were impacting his French horn playing physiologically.

“It changes the position of the compression in the oral cavity,” says Factor. “You want it to be up at the lips where the vibration actually happens—that’s the balance point between your body and the instrument. But the pharyngoceles make it more volatile, and then I don’t get the right kinds of pressure up at the lips, which influences the tone, volume, and all kinds of executive functions.”

Schneider and Factor initially thought they’d try physical therapy to see if strengthening the neck muscles could help.

“It didn’t end up helping the pharyngoceles at all,” says Factor. “Which makes sense, because when you’re playing, that whole part of your body should be relaxed; you’re not flexing the muscles.”

Instead, Schneider suspected some sort of brace could help mitigate the pharyngoceles’ effects. He immediately thought his colleague Amy Lerner, a professor with URochester’s Department of Biomedical Engineering, would be the perfect person to design such a brace.

Making space for a solution

Lerner has a long history working at the intersection of biomechanics and design, which dates back to her time in the aerospace industry designing space suits for NASA’s Space Shuttle program. While working for ILC Dover in the 1980s, she designed grooved gloves that give astronauts the dexterity and durability to handle tools and make repairs to the International Space Station. Elements of her designs remain in today’s space suits.

Lerner says other aspects of space suits inspired the brace she designed for Factor.

“A spacesuit is essentially a big balloon, but if you blew it up entirely, it would be a big cylinder, and you couldn’t bend anything,” says Lerner. “So, while working on the shuttle space suit program, we designed a restraint system in the suit that prevents the balloon from expanding in certain locations. That mirrors this challenge in a lot of ways.”

Through various iterations and conversations with Factor, Lerner designed a collar that he can easily wrap around his neck and secure with hook clips and adjustable straps. The collar has rigid inserts positioned strategically to prevent his neck from bulging when he plays, similar to how a hernia belt works.

“I designed it to be comfortable for him, so it fits when he’s breathing, walking, talking, and preparing in between breaths, but when he needs to create the pressure to play the French horn, it’s restraining in the right locations,” says Lerner.

Factor says the brace has been a revelation, and he now plays the French horn exclusively while wearing it. And he says it clearly makes a difference in his performance.

“Everybody that I’ve played for—musicians or non-musicians—has noticed a difference in the way I sound,” says Factor. “Even my mom notices a difference.”

Measure for measure

Not satisfied with anecdotal evidence that his playing had improved, Factor wanted to quantify the difference. Lerner brought in her colleague, Professor Zhiyao Duan from the Departments of Electrical and Computer Engineering, Sound Arts and Engineering, and Computer Science.

Duan and his PhD student Baotong Tian, who produces music in his spare time, devised a series of experiments to analyze how the brace changes the audio characteristics when Factor plays the French horn. They recorded him playing the same piece with and without the brace using the same microphones in two different settings—a professional recording facility in Rettner Hall and an anechoic chamber, a heavily insulated room designed to produce no echoes.

“By studying in the anechoic chamber, we can analyze the sound waves coming right from the instrument. The studio, meanwhile, has more lively acoustics similar to the places he typically performs. Both settings have pros and cons for analysis,” says Duan. “Looking at the frequency spectra, we can see that with the brace on, the sounds are brighter, meaning there are greater concentrations of high frequencies in the audio compared to without the brace.”

They identified significant differences in the spectral energy distribution across frequencies when Factor wore the brace, confirming their hunch that he could hit the high notes better.

The team is working on documenting their results in scientific papers to share their findings with the world. As Factor finishes the last components of his PhD program, he hopes to apply the lessons he learned in his career as a music educator. “I want to raise awareness for the condition with wind instrument educators at all levels. If they’re aware of it, they can more appropriately adjust what they’re doing with students to help them,” says Factor. “I received a lot of very blanket pedagogy that never helped me. ‘Use more air’ was never the answer to this problem.”